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As hospitals in Canada struggle with an influx of children dealing with respiratory illnesses, the ongoing shortage in children鈥檚 Tylenol is only complicating the problem, experts say.

Fevers that may have been handled at home with the proper over-the-counter medication are now driving concerned parents to take their kids into emergency rooms that are already dealing with children who are seriously ill.

鈥淚t鈥檚 the Tylenol and Advil shortage that鈥檚 making (some families) come to ERs, come to hospitals,鈥� Eram Chhogala told CTVNews.ca in a phone interview.

鈥淭hey go to the stores, pharmacies and there's nothing there, then that's when they come into the emergency department in hopes of obtaining (...) medication.鈥�

In the last few weeks, children鈥檚 hospitals and health-care professionals have been sounding the alarm about children coming down with respiratory illnesses.

Some hospitals are operating at or over 100 per cent occupancy, being seen 鈥渁bove expected levels for this time of year,鈥� according to the Public Health Agency of Canada.

This influx in respiratory illnesses isn鈥檛 caused by the ongoing shortage in children鈥檚 Tylenol 鈥� but Chhogala, a registered nurse in Toronto, says that shortage is exacerbating the issue.

Because she works in the emergency department, she sees a mixture of adult and pediatric patients, but she says the recent uptick in children being brought into the ER with respiratory symptoms is clear.

These patients include those experiencing significant illness with influenza, COVID-19 and a common childhood respiratory infection called RSV, she says, but some of the children with fevers in the ER are there because worried parents didn鈥檛 know what to do amid 鈥渢he lack of access to Tylenol and Advil in a lot of the stores and pharmacies and so forth.

鈥淚t鈥檚 really caused a high influx of patients coming in,鈥� she said.

Fever is an ordinary part of the immune response for many viruses, and isn鈥檛 something to panic over on its own. But with trusted medication vanishing from the shelves, many parents feel stranded.

Pharmacists and hospitals began to raise flags about a supply issue with liquid Tylenol and Advil in early summer, with Health Canada confirming that there was a national shortage. The shortage has only increased since then, with the Ontario Pharmacists Association stating in September that liquid and chewable forms were growing scarce.

• Read more: Begging friends for help and shipping overseas: Here's how far parents are going to find medication for their kids

While supply chain issues are believed to be a contributor to the issue, in Health Canada鈥檚 most recent update they state that 鈥渦nprecedented demand鈥� is the key source of the shortage.

TYLENOL SHORTAGE CONTRIBUTING TO CRUSH

In the summer, health professionals began to advise parents to ask their family doctors for a prescription for children's Tylenol if they were unable to locate any on the shelves at their local drug store, in the hopes that this could help them access a supply that hadn't yet been exhausted in regions running low.

However, many families are now ending up in the ER as avenues to find this over-the-counter medication are growing slim, Chhogala says.

"Because there's not very much access to walk-in clinics or family doctors, they just 鈥� come to the ER, because they don't have access to Tylenol or Advil or children's Motrin,鈥� Chhogala said.

Even pharmacies attached to hospitals are running out of Tylenol.

鈥淭he other day, I walked into the hospital鈥檚 pharmacy, just to grab something to drink, and I saw that the shelves were just empty. And there were families in there looking for Tylenol and there was nothing,鈥� Chhogala said.

鈥淪o they come in [to the ER] because they're hoping 鈥� that we can basically administer the Tylenol or Advil in the emergency department.鈥�

Tylenol is a brand name for acetaminophen, while ibuprofen is marketed under the brand names of Advil and Motrin. It's not necessary to get a prescription to obtain this medication, but emergency departments have their own stock that is separate from that in the pharmacy to ensure that those in emergency need can have access.

Children鈥檚 Tylenol and Advil can be used to help lower a fever and make a sick child feel less discomfort as their body battles the virus.

鈥淎dvil and Tylenol have one role. And that's to make a child more comfortable,鈥� Fahad Masud, a pediatric emergency doctor at the Children鈥檚 Hospital of Eastern Ontario, told CTVNews.ca on Friday.

He explained that parents shouldn鈥檛 worry that the presence of a fever alone means they have to scramble to find medication to lower it immediately 鈥� fever by itself won鈥檛 cause worse illness and many fevers will clear up as the illness improves. But it鈥檚 never pleasant for the patient.

Chhogala said she and her colleagues have heard of patients having a fever for 鈥渕ore than maybe four or five days鈥�, during which time the parents were not able to find any Tylenol or Advil over the counter to address it.

With staffing shortages still plaguing Canada鈥檚 health care system amid the COVID-19 pandemic, the Tylenol shortage exacerbating the increase in children in the hospital is just adding more strain to workers.

鈥淲ith nursing staffing shortages, it's quite a heavy load on our end, just because there's so many patients and where do we put them to be seen?鈥� Chhogala said.

鈥淲hen you have a high number of patients to a low number of nurses, providing quality care is something that becomes [difficult]. And you want to be able to provide the best quality care for patients and their families out there.鈥�

WHAT PARENTS CAN DO

Parents who are concerned that the flu could lead to their child being one of many in an overcrowded hospital should think of prevention first, Chhogala said.

They should start with the basic health measures that not only help fight COVID-19, but served to keep cold and flu levels down the past two years: wearing masks and thorough hand washing.

鈥淭hat's something that's very, very important,鈥� she said.

If a child does fall ill, parents should monitor their symptoms carefully.

If there is no Tylenol or Advil available over-the-counter in drug stores in their region, parents can try asking their family doctor, check in at walk-in clinics or try virtual care services that may be able to provide guidance.

If these options have been exhausted, a child who appears to be very ill and has a high fever should be brought to the ER to receive treatment, Chhogala said.

However, identifying the difference between a very sick child and one with milder symptoms can help fight the numbers clogging up ERs and pediatric hospitals.

Chhogala said that she looks at the child鈥檚 symptoms as well as how high their fever is.

鈥淢onitor the child's symptoms in terms of are they looking lethargic, are they having changes in behaviour or altered mental status,鈥� she suggested. 鈥淚ncreasing their fluid intake, that's something that's really important, because a lot of fluid intake can assist with keeping the child hydrated, and alleviating a bit of the fever symptoms.

Other symptoms denoting a more serious illness include the child looking very dehydrated, with lips that are turning blue or are dry and sticky.

She considers a fever below 38.5 C to be a low-grade fever that likely wouldn鈥檛 require medication, while a fever of 40 C or higher would cause her to recommend the parents seek medical care.

However, Masud said that the number itself is not the point 鈥� a child who is very ill with a respiratory illness will have symptoms beyond a fever.

鈥淸In general] the number of your temperature doesn鈥檛 tell you who鈥檚 more sick or less sick,鈥� he said. 鈥淭here鈥檚 kids who are sometimes running around with a fever 40-point-something, which I鈥檓 amazed by, but it doesn鈥檛 matter because the height of the temperature is not an indication of the height of seriousness. It's more how the child looks.鈥�

An eight-year-old who is lethargic, won鈥檛 eat and has had a fever of 38.7 C for two days is likely sicker than an eight-year-old on day three of a fever of 39.5 who is alert, talkative and not having trouble staying hydrated, Masud said.

He also stressed that a child with flu symptoms who is struggling to breathe needs to be seen by a doctor.

The only time that a fever alone is enough to prompt an ER visit, Masad said, is if it is in a child younger than three months old.

鈥淚f it's somebody below three months with a fever of 40, I wouldn't even ask you what the next part of the scenario is because it's full stop, they need to go to [the ER],鈥� Masud said.

Chhogala acknowledged it鈥檚 difficult for parents to know what to do at this time, 鈥渨here we have a shortage of Tylenol.

鈥淛ust because it was so readily accessible before and now 鈥� there鈥檚 pretty much nothing left.鈥�

Tylenol shortages may make parents want to stock up, but it鈥檚 important not to take more than your fair share.

鈥淛ust be mindful that if there's Tylenol that's reintroduced on the shelf, not to take so much Tylenol for your own self,鈥� Chhogala said. 鈥淵ou need to be considerate of other families that are out there that maybe don't even have access to even one bottle.鈥�

She added that it鈥檚 a 鈥渧ery unprecedented and scary time for a lot of people,鈥� stressing that health-care professionals just want to help as many people as possible.

鈥淲e're doing our very best in the emergency departments to accommodate all families, all children, we do see everybody, and we welcome anyone who really does require to come in to be seen by a doctor,鈥� she said. 鈥淏ut please bear with us and please be patient, we are doing our very best to do as such, because we do genuinely care and we do genuinely want everyone to receive the care that they deserve.鈥�